Provider Demographics
NPI:1780708883
Name:KOCH, SHERRY LYNN (RNFA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:KOCH
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-433-5441
Practice Address - Street 1:6100 HARRIS PARKWAY,
Practice Address - Street 2:SUITE 320
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-433-5499
Practice Address - Fax:817-433-5441
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237563163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant